Current state of hand transplantation

master's thesis

• Author: Simon André Wellner
• Mentor: Rado Žic (mentor)
• Committee member: Srećko Budi (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Rado Žic (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

The loss of one or both hands causes a major psychological and social impact. Throughout history there have been numerous attempts at trying to restore normal function to the amputated hand by using prosthesis. Hand transplantation was not attempted until 1964 and the first successful hand composite tissue allotransplantation (CTA) was performed in 1998 in Lyon France. Both hand transplantations and prosthetic devices have advantages and limitations. Lifelong immunosuppression is required for hand (CTA) and the prosthetic devices are heavy and require mandatory visual control when using the device. Hand transplantation leads to great functional outcomes with physical rehabilitation, in the long run. Prosthetic devices do not require immunosuppressive therapy or surgery. The ideal candidate for hand transplantation is a bilateral distal trans-radial amputee already on immunosuppressive therapy due to a life-saving procedure. The functional outcome of many of the patients are excellent and enables them to return to daily activities such as personal hygiene, grooming and driving a car. Many were able to return to work after one year. Psychologically it was toughest for a patient in a review, the 6th week after surgery. This was due to initial emotions of helplessness and dependence following the operation. Moreover, it was felt that initial functional capabilities of the transplant were very limited. After this period, however, when more functionality was restored the patient felt much better psychologically. Cortical reintegration and nerve regeneration is imperative for achieving a functional result of the hand transplant. Rehabilitation after surgery is very tough lasting 4-6h on an almost daily basis, but is gradually decreased. There are acute and chronic complications of the hand transplant surgery. The acute complications are categorized into medical and surgical. Chronic complications are mostly due to the immunosuppressive therapy. The future of hand transplantation is closely related to the development of better prosthetic devices that can match the functionality of a hand transplant. There has been research about induction of chimerism by infusing donor bone marrow in the recipient. This brings the possibility of being able to decrease the amount of immunosuppressive therapy given to the patient.

• Keywords: hand transplantation; advantages; limitations; prosthetic devices; outcomes; rehabilitation
• Language: english
• URN:NBN: urn:nbn:hr:105:131793
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-08-31 09:38:10